Provider Demographics
NPI:1164688495
Name:PREFERRED HOSPITAL LEASING JUNCTION, INC
Entity Type:Organization
Organization Name:PREFERRED HOSPITAL LEASING JUNCTION, INC
Other - Org Name:KIMBLE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-878-0202
Mailing Address - Street 1:120 W MACARTHUR ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-2007
Mailing Address - Country:US
Mailing Address - Phone:405-878-0202
Mailing Address - Fax:405-273-6007
Practice Address - Street 1:349 REID RD
Practice Address - Street 2:
Practice Address - City:JUNCTION
Practice Address - State:TX
Practice Address - Zip Code:76849-3049
Practice Address - Country:US
Practice Address - Phone:325-446-3321
Practice Address - Fax:325-446-3769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100014282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-1306Medicare PIN